Vision Rehabilitation Content in Occupational Therapy Curricula in Arab Countries.

BACKGROUND: Vision rehabilitation (VR) is a relatively new field for occupational therapy (OT) in Arab countries. To date, no studies have examined VR content in the curricula of OT programs in these countries. AIM: The primary objective of this study was to investigate the characteristics of VR content in the curricula of OT undergraduate programs in nine Arab countries. METHODS: An online survey was created using Google Forms and used to collect the details regarding VR content in the OT curricula. The survey link was sent by email to the directors of 19 OT pro¬grams in these countries and the collected responses were analyzed. RESULTS: Most program directors responded (n=16). Most programs (69%) covered some content of VR, whereas some programs (31%) did not. Most of the programs that covered VR had faculty members with a degree in VR (64%) and provided clinical internships at VR facilities (64%). CONCLUSIONS: There was significant variability in the VR content, faculty qualifications, and characteristics of clinical internship between the OT programs in Arab countries. These results may help in the development of VR education in these programs and, consequently, may improve the VR knowledge and skills of these programs' graduates.

Quantifying Lumbar Mobilization With Inertial Measurement Unit.

OBJECTIVE: Lumbar mobilization is a standard intervention for the management of low back pain, yet ways to quantify lumbar mobilization are limited. An inertial measurement unit (IMU) is a small and inexpensive device that can be used to quantify lumbar mobilization. The objective of this study was to determine the validity and reliability of an IMU in measuring the amplitude of displacement of a clinician's hand movement during oscillatory lumbar mobilization. METHODS: An IMU was secured on a clinician's hand during application of mobilization forces at the L4 segment of 16 healthy participants. The validity of the IMU was tested against common laboratory methods of measurements (force plate and motion capture system). The reliability of the IMU measurements was determined between 2 clinicians (inter-rater reliability) and between 2 sessions (intra-rater reliability) by calculating percent error of measurement (%e) and limits of agreement (LOA). The reliability was considered high when |%e| ≤ 10% and |LOA| ≤ 20%; moderate when |%e| 10% to 20% and |LOA| 21% to 40%; and non-acceptable when |%e| > 20% and |LOA| > 40%. RESULTS: The IMU measurements had high correlation with the force plate measurements (rs = 0.94) and high agreement with the motion capture system measurements (%e = 4%, LOA = -11% and 20%). Both the inter-rater reliability (%e = 6%, LOA = -25% and 37%) and the intrarater reliability (%e = -1%, LOA = -29% and 27%) of IMU measurements were moderate. CONCLUSION: The IMU seems to be a valid device to measure the amplitude of a clinician's hand movement. The moderate reliability found in this study may not reflect poor reliability of the IMU as much as inconsistency in reapplication of lumbar mobilization.

Effect of Grade III Lumbar Mobilization on Back Muscles in Chronic Low Back Pain: A Randomized Controlled Trial.

BACKGROUND: Lumbar mobilization is a standard intervention for lower back pain (LBP). However, its effect on the activity of back muscles is not well known. OBJECTIVES: To investigate the effects of lumbar mobilization on the activity/contraction of erector spinae (ES) and lumbar multifidus (LM) muscles in people with LBP. DESIGN: Randomized controlled study. METHODS: 21 subjects with LBP received either grade III central lumbar mobilization or placebo (light touch) intervention on lumbar segment level 4 (L4). Surface electromyography (EMG) signals of ES and ultrasound (US) images of LM were captured before and after the intervention. The contraction of LM was calculated from US images at L4 level. The normalized amplitude of EMG signals (nEMG) and activity onset of ES were calculated from the EMG signals at both L1 and L4 levels. RESULTS: Significant differences were found between the mobilization and placebo groups in LM contraction (p=0.03), nEMG of ES at L1 (p=0.01) and L4 (p=0.05), and activity onset of ES at L1 (p=0.02). CONCLUSION: Lumbar mobilization decreased both the activity amplitude and the activity onset of ES in people with LBP. However, the significant difference in LM contraction was small and may not have clinical significance.

Trunk Control Response to Unstable Seated Posture During Various Feedback Conditions in People with Chronic Low Back Pain.

AIMS: People with chronic low back pain (CLBP) tend to have altered postural control. Visual biofeedback may be used to restore postural control. The purpose of this pilot study was to investigate the effect of visual biofeedback on seated postural trunk control in subjects with CLBP, and to investigate the relationship between the postural control parameters and clinical tests. METHODS: Ten CLBP subjects (8 female, 2 male; age 40.6±5 yrs; BMI 25.06±2.93) and 10 healthy matched controls (8 female, 2 male; age 41.2±5.88 yrs; BMI 24.61±3.17) underwent seated postural assessment. Center of pressure (COP) parameters were collected under three experimental conditions: eyes-open, visual biofeedback, and eyes-closed. RESULTS: The results revealed that COP velocity was significantly different between healthy and CLBP subjects for each condition, both healthy and CLBP subjects had no differences in COP parameters between eyes-open and visual biofeedback conditions, and in subjects with CLBP, the straight leg raise clinical test had a strong negative correlation with all COP parameters. CONCLUSIONS: Our results suggest that 30-second visual biofeedback training did not improve the seated postural control of CLBP subjects, potentially due to the short duration of training, and that hamstrings muscle tightness or decreased sciatic nerve mobility was associated with worse postural control.

Immediate Effect of Lumbar Mobilization on Activity of Erector Spinae and Lumbar Multifidus Muscles.

OBJECTIVE: The purpose of this study was to investigate the effect of grade IV lumbar mobilization on the activity/contraction of erector spinae (ES) and lumbar multifidus (LM) muscles in healthy people. METHODS: A randomized, repeated-measures design was used. Sixteen healthy subjects attended 3 testing sessions with a different intervention in each session (no intervention, grade IV central lumbar mobilization at L4, and placebo/light touch). Lying in a prone position, subjects lifted a light weight with their right arm while ultrasound images of LM and surface electromyography signals of ES were captured before and immediately after application of the intervention in the session. The contraction of LM was calculated from US images, and the root mean square was calculated from the electromyography signals of ES and used as outcome measures. RESULTS: A significant difference was found in LM contraction between the placebo and mobilization intervention (difference = 0.04, P = .02). There was no difference for the root mean square of electromyography signals between the interventions. CONCLUSION: The significant difference in LM contraction was small and may not have clinical significance. Lumbar mobilization did not change the activity of ES in healthy people. Future studies with larger samples are needed to confirm our findings and to investigate the effect of mobilization on back muscles in people with low back pain.

Reliability of Ultrasound Imaging for Lumbar Multifidus Muscle: Capturing Video vs Static Images.

OBJECTIVE: Ultrasound imaging is a widely used method for viewing musculoskeletal tissues. However, capturing movies of lumbar multifidus (LM) muscle with ultrasound imaging (video method) is a relatively new method, and its reliability has not been fully tested. The objective of this study was to compare the intra-rater reliability of two methods of ultrasound imaging of LM muscle, the traditional method (static images) and the video method, in healthy subjects conducted by a novice rater. METHODS: Images of LM thickness in 15 healthy subjects were captured and measured by static images and video methods. Intra-class correlation coefficient (ICC) with 95% confidence interval, standard error of measurement, and minimal detectable change were calculated to determine the reliability and precision of the LM thickness measurements. RESULTS: Excellent intra-rater reliability was demonstrated in measuring LM muscle thickness using both methods, with the intra-rater ICC ranging from 0.75 to 0.95. CONCLUSION: The reliability of the LM thickness measurements in video ultrasound is similar to that in the static images method in healthy subjects.